Baby care - back to basics™

(version 9 - sponsored by Weleda UK)

Recent research suggests that it is safer to bath your baby in plain water for at least the first four weeks of life.

At birth, the top layer of your baby’s skin is very thin and absorbent. This means it is more sensitive to damage from germs, chemicals and water loss. Over the first month (longer in premature infants) your baby’s skin matures and develops its own natural protective barrier or microbiome. It appears that microbial bacteria picked up from the mother during birth and from the mother’s skin, help to build and support the baby’s immune system. This takes time therefore babies should not washed too soon after birth.

Remember that anything placed on, in or around your baby has the potential to harm.

If you follow the advice in this section, you will give your baby the best possible start in life.

Cord care

Cord care for the healthy term baby: Keep the area around the cord clean and dry. After the first bath in plain water, pat this dry with a clean towel. Fold the nappy back at each change until the cord falls off. In the first few days, you should only top’n’tail your baby to allow the cord to separate naturally. Only use wet cotton wool to clean the area if it is dirty - otherwise leave it alone. You don’t need to use antiseptic wipes or powders. Some maternity units remove the cord clamp, others don’t. If the cord or surrounding area becomes red or smelly, tell a member of staff.

Cord care for the sick or premature baby: This may be a bit different, as there is a higher risk of infection with these babies. Antiseptic solutions or powders may be used for the first few days, but otherwise cord care should be the same as for other babies. Staff in the neonatal unit will advise you.

Bath care

It is very important to wash your hands thoroughly before and after carrying out any baby care.

Your baby’s first bath should be done with plain water but only once baby's temperature has stabilised. This will help to protect the delicate skin while it is vulnerable to germs, chemicals and water loss. Continue bathing your baby with plain water for at least the first month before gradually introducing baby products. By this time the skin’s natural barrier will have developed. These products should be free from sulphates (SLS and SLES), parabens, phthalates, artificial colours and perfumes.

Daily baths can dry the skin. It's enough for baby to have 2 or 3 baths a week.

Wash clothsshould be avoided as they can be harsh. Hand washing your baby, cotton wool (organic is better) or a natural sponge is gentler.

A baby comb can be used to gently remove any debris from thick hair.

It is best to leave the delicate area around the eyes untouched. If it becomes sticky, ask a member of staff for advice. The ears and nose should also be left alone and cotton buds should not be used.

Vernix (the white sticky substance that covers your baby’s skin in the womb) should always be left to absorb naturally. This is nature’s own moisturiser. Vernix gives added protection against infection in the first few days of life.

Premature babies’ skin is even more delicate, so it is important to take extra care. Research has shown that massaging premature infants with pure vegetable oils can give some protection against skin infections. Staff in the neonatal unit will be happy to advise you.

If your baby is overdue, their skin may be dry and cracked. This is because the protective vernix has been completely absorbed. Don’t be tempted to use creams or lotions as this may do more harm than good. The top layer of your baby’s skin will peel off within a few days leaving perfect skin underneath. Remember to use plain water only for at least the first month.

Washing baby's bottom - Girls should be cleaned from front to back (to avoid passing germs into their vagina). Boys should be cleaned carefully around their testicles and penis.

Handy tips

Baby wipes should not be used for the first month. After this, try to use wipes that do not contain alcohol, parabens, phthalates, artificial colours or perfumes.

It is safer to file nails with a soft nail file rather than use scissors, which can leave sharp edges. Baby nails that have started to come away can be peeled off gently.

You don't need to wash baby’s hair with shampoo until they are a year old. Once you have started to use baby bath products, simply rinse your baby’s hair in the bath water. Check that any shampoo you use doesn’t contain sulphates (SLS and SLES).

The only exception to the ‘water only’ rule is barrier balms. You may like to use a thin layer of barrier balm on the nappy area although it is not necessary after each nappy change. Choose a cream that doesn't contain any preservatives, colours, perfumes, or antiseptics, and is clinically proven to be effective in the treatment of nappy rash. Always wash your hands carefully before using a nappy balm. This will help reduce the risk of bacteria passing from your fingers to the product and ensure that the nappy balm is effective for longer.

If after a few weeks you decide to use baby skincare products always read the label very carefully. Do not use products that contain ingredients your baby is sensitive to. Test the product on a small area of skin before you use it for the first time - even if the product claims to be natural or organic. This is to make sure your baby does not suffer any reaction.

When washing your baby’s clothes and bedding remember not to overload the washing machine – this is to make sure everything is rinsed thoroughly. If you use a fabric conditioner make sure it is mild and doesn’t contain any colours or strong perfumes.

Cloth nappies are as efficient as disposable ones and your baby is not more likely to develop nappy rash if you use these.

Skin-to-skin contact and baby massage - The benefits of skin-to-skin contact cannot be overstated. It should be strongly encouraged from birth. As well as promoting successful breastfeeding, skin-to-skin contact stabilises your baby’s heart rate and temperature. Baby massage follows on naturally and many parents enjoy doing this. You should try and avoid using petroleum based oils and oils with perfumes. If there is a history of nut allergies in your immediate family you should also avoid nut-based oils.

Even some vegetable oils are not ideal for delicate baby skin. For example, olive oil is high in oleic acid - unfortunately this can have the same effect on the skin as detergents, stripping away the delicate barrier that protects baby's skin. This can dry baby's skin and make it more prone to eczema. Being more absorbent, dry skin absorbent allows potentially damaging chemicals to penetrate the epidermis more easily.

It is safer to use oils that are lower in oleic acid and higher in linoleic acid, for example sunflower, sesame seed, evening primrose, or pomegranate oil - organic is always best.

If possible, ask a qualified baby massage therapist for their advice - find someone near you on the UK website of the International Association of Infant Massage (www.iaim.org.uk).

Sun protection - look after your baby’s delicate skin when the weather is hot, as they can quickly get sunburn. Keep babies under a year old out of direct sunlight. You can find out how best to protect older babies and children from the sun in our Skincare FAQs

Diet tips

Breastfeeding is best for your baby: it strengthens their immune system, giving some protection against allergies developing.

Moving on to solids whether you breastfeed or bottle-feed, weaning should not start before your baby is six months old. Your health visitor or dietician will be happy to tell you what foods to introduce and when - their advice is especially important if there is a history of allergies in your family. Like breastfeeding, weaning should always be ‘baby-led’ - this means that you should let your baby feed themselves from the very start of weaning. You can find out more about this online: go to www.baby-led.com

From the age of six months your baby should start to drink from cups without teats or spouts - these are often called ‘open top cups’. Babies over one year old should not drink from bottles.

Place your baby with their feet to the foot of the cot to prevent wriggling down under the covers.

The safest position for your baby to sleep is on their back.

Baby should sleep on a well-fitted firm mattress but not on a water bed or bean bag.

Baby should sleep in your room, day and night, for the first six months.

You may find that breastfeeding is more successful if you share a bed with your baby. Breastfeeding helps you tune into your baby’s needs and may be easier at night if you share a bed (as long as you follow the Safety first advice below).

Safety first

Never sleep with your baby on a sofa, armchair or settee.

Never share a bed with your baby if you or your partner:

are smokers (no matter where or when you smoke)

have been drinking alcohol

take medication or drugs that make you drowsy, or

feel very tired.

Using dummies - what you need to know

Claims that dummies reduce the risk of cot death are not based on strong evidence. Brian Palmer DDS, internationally recognised researcher, has done extensive research on the possible increased risk of cot death linked to bottle feeding and the use of dummies. For more information visit Brian Palmer’s website (www.brianpalmerdds.com).

Remember that, when used a lot, dummies may permanently change the shape of a baby’s mouth and jaw affecting its correct development. This may lead to breathing difficulties called Obstructive Sleep Apnoea (OSA).

You may still receive free samples, whilst in the maternity unit or shortly afterwards. However, we recommend you do not introduce the baby skincare products until your baby is at least one month old. This information is a guide and whilst every effort is made by TIPS Ltd to ensure the information is accurate and up-to-date, please seek the advice of your midwife, health visitor, lactation consultant or GP if you have any queries or concerns.

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Professionals can order TIPS educational pack. This includes: 1 'Breastfeeding: the essential guide' book + 50 'Baby care - back to basics' leaflets. A pack costs £25 (including P&P to any UK address).
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Sharon and her Babycare -back to basics™ leaflet won the very first Nursing in Practice Dermatology Award

Sharon (above) was thrilled to be shortlisted in 2 categories (Innovator of the Year and Nurse of the Year) for her work on baby skincare at the 2011 General Practice Awards. You can find out more here...